Introduction
Barium studies, such as barium swallow, barium meal, or barium enema, involve the use of barium sulfate, a contrast agent that enhances the visibility of the gastrointestinal tract on X-rays. These procedures help diagnose conditions like ulcers, tumors, strictures, or motility disorders.
Definition
Barium Swallow
It refers to the oral administration of barium sulfate suspension for radiographic investigation of the hypopharynx and oropharynx.
Barium Meal
It refers to the oral administration of barium sulfate suspension for radiographic study of the upper gastrointestinal tract.
Types of Barium Administration
- Double contrast studies: This is a method of examining the upper gastrointestinal tract and involves administering a thick barium suspension medium to outline the stomach and esophageal wall. Tablets that release CO₂ are given to produce a double-contrast effect.
- Continuous infusion method: A detailed study of the small intestine, which involves continuous infusion through duodenal tube of 500-1000 mL. of thin barium sulfate suspension. As the barium column fills the intestinal loops, it is observed continuously by fluoroscope and filmed at frequent intervals as it progresses through jejunum and ileum.
Purposes of Barium Studies
Barium Swallow
- To outline the esophagus.
- To reveal displacement of esophagus.
- To reveal encroachment of esophageal lumen by cardiac, pulmonary or mediastinal abnormalities.
Barium Meal
- To outline the stomach and esophagus.
- To diagnose early superficial neoplasms.
- To outline jejunum and ileum if any cysts or abscess is present either intrinsic or extrinsic.
Contraindications
- Acutely ill patients.
- Gastrointestinal perforation.
- After gastrointestinal surgery.
- Previous history of anaphylactic reaction
Preparation of the Patient for Barium Studies
- Fasting:
- Patients are typically required to fast for 6-8 hours before the procedure to ensure the stomach and intestines are empty.
- Avoid smoking or chewing gum, as these can stimulate gastric secretions.
- Dietary Restrictions:
- A low-residue diet may be recommended for 1-2 days before the procedure to reduce bowel contents.
- Medication Adjustments:
- Patients should inform their healthcare provider about any medications they are taking, especially blood thinners or diabetes medications, as adjustments may be needed.
- Clothing and Accessories:
- Patients should wear loose, comfortable clothing and remove any jewelry or metallic items that could interfere with imaging.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions, and obtain informed consent.
Procedure Barium Studies
| Nursing action | Rationale | |
| 1. | Explain about the procedure, the place where it will be done, personnel involved, and machines used and obtain informed consent. | Provides reassurance and reduces anxiety. Safeguards the institution from litigation. |
| 2. | Instruct to take low residue diet for the preceding 3 days and to take nothing by mouth from midnight prior to the test. | Facilitates an empty, clean gastrointestinal system for radiographic view. |
| 3. | Administer laxative and enema as prescribed prior to the test. | Empties bowel of fecal matter so as to obtain clear X-ray films. |
| 4. | Instruct to avoid smoking in the morning before test. | Reduces gastric motility caused by nicotine. |
| 5. | Suggest to have some reading material as the procedure takes 5-6 hours. | Provides diversion of mind and lessens anxiety. |
| 6. | Administer premedication including antihistamine as prescribed. | Avoids allergic reaction to barium. |
| 7. | Have client history about any sensitivity reaction and keep vasopressin, IV fluids, antihistamine and steroids ready prior to starting the procedure. | Gives opportunity for timely management of possible anaphylactic reaction. |
| 8. | Instruct client that a series of X-rays will be taken. | |
| 9. | Offer a mouth wash after the series is completed. | Cleanses mouth of the chalky barium particles that clings to the oral mucosa. |
| 10. | Provide a meal at the completion of the procedure as informed by the radiologist. | Reduces the anxiety and nervous stimulation caused by fasting for several hours. |
| 11. | Instruct client to increase the fluid intake. Mild laxative or cleansing enema is given if ordered. | Washes out the barium that clings to the mucosa of the Gl tract. Promotes elimination of barium and relieves constipation. |
Special Consideration
- Confirm the patient has followed pre-procedure instructions, such as fasting and avoiding certain medications.
- Address any anxiety by explaining the procedure clearly and reassuring the patient.
- Observe the patient for signs of discomfort or complications, such as aspiration or allergic reactions.
- Ensure the patient is positioned correctly to optimize imaging results.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure the barium solution and imaging equipment are properly prepared and functioning.
- Monitor the patient for delayed complications, such as bowel obstruction or allergic reactions.
- Provide clear instructions for recovery, including hydration to help clear the barium from the system.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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